Provider Demographics
NPI:1275825879
Name:SMITH, RYAN (BS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 PLUMAS ST APT H
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89519-6025
Mailing Address - Country:US
Mailing Address - Phone:775-762-4802
Mailing Address - Fax:
Practice Address - Street 1:6050 PLUMAS ST APT H
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89519-6025
Practice Address - Country:US
Practice Address - Phone:775-762-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program